Forward hand in hand

The role of the health service in the adult social care green paper
is not always clear. There is a chapter on strategic commissioning
which talks about strengthening the duty for local authority and
NHS commissioners to co-operate on adult care services. But it
leaves only a vague impression of how community health and social
care will fit together.

Such doubts are the main reason why there has been some recent
debate about whether, rather than the adult social care white paper
originally promised for later this year, there should instead be an
adult social care and health white paper. The advantages are
obvious: if the objectives of the green paper are to be realised,
they can only be so in the context of a radically reformed health
service. From this point of view, the white paper already planned
on out-of-hospital health care may also be a suitable vehicle for
the definitive vision of social care that is supposed to emerge
from the current consultation process. It would be a prelude to
health and social care legislation promoting a “whole-systems
approach” to care.

This would certainly be better than the other recently mooted
scenario, one in which there is no legislative sequel to the adult
social care green paper at all because of the costs. Although it is
true that much progress can be made with direct payments,
self-assessments and a good deal more in the existing legal
framework, achieving the green paper’s ambitious vision in
full will require new law. The advantage of a joint health and
social care white paper would be that the financial implications
could be considered in the round. If joint commissioning and pooled
budgets are working as they should be, the potential for shifting
NHS funding from acute care into community care is significant. But
this will not happen unless it is given even more legislative
momentum than it has already, especially where primary care trusts
still need to be shaken out of their inertia.

The danger of joint legislation must be that social care becomes a
mere outpost of the NHS with its values and identity under threat.
Measured purely in terms of service delivery, it makes sense for
the two sides to go hand in hand. But will the professional price
of doing so be even more prohibitive than the cost of the
implementing the green paper?